In predominantly Hispanic Miami-Dade County, where one in three residents is uninsured, the National Hispanic Council on Aging identified ripe territory last fall to execute its federally funded mandate: seek out and sign up eligible Hispanics for coverage under the Affordable Care Act.
But seven months after receiving a $646,000 federal award to act as a “navigator,” or counselor who walks consumers through the enrollment process, the Washington-based group has reported signing up about 350 people — fewer than other groups that received less money to cover more of South Florida.
Though enrollment is lagging among Hispanics nationwide and only two weeks remain to sign up for coverage under the health law, NHCOA officials say there are good reasons for their low numbers: misinformation about the health law, and a population that is hard to reach and harder to educate.
“The community that we serve is mostly monolingual. They have very low level of education. They are very afraid to ask questions,” said Maria Eugenia Hernandez-Lane, NHCOA’s vice president.
She said the group isn’t trying to reach “everybody in the Latino community. These are the people who, in any program, they are always left behind. … It’s very hard to reach them. They go to bed hungry because they don’t know how to ask for assistance.”
A review of state records, however, tells a different story: NHCOA was late getting off the ground in South Florida, where its only longtime partner is Abriendo Puertas, a Little Havana nonprofit social services agency.
Other navigators and independent nonprofits working to educate and enroll consumers in Miami-Dade say NHCOA is nowhere to be found, and that the group doesn’t have many counselors or community partners — causing a missed opportunity for the Obama administration, which expected Hispanics to be major beneficiaries of the health law.
NHCOA did not license a single navigator in Florida until Dec. 12, more than two months after open enrollment began Oct. 1, according to the state’s Department of Financial Services.
And even now, the group has licensed just 18 individuals as navigators in Miami-Dade, fewer than another local navigator group, Epilepsy Foundation of Florida, which has licensed 55 navigators throughout the state and dedicates 22 to Miami-Dade despite receiving a slightly smaller federal grant than NHCOA.
Epilepsy Foundation — with a $637,000 grant — licensed its first navigator on Sept. 24.
Hernandez-Lane could not explain why NHCOA — which won an additional $646,000 navigator grant in Dallas — waited until December to license its first counselor with the state, saying only that, “They just had to study, really study hard.”
With an estimated 744,000 Miami-Dade residents lacking health insurance in 2011 — more than any other county in Florida, according to the U.S. Census — others working to enroll eligible Floridians had higher expectations for the group that received more money than any other navigator in the county and the only one with a mandate to sign up Hispanics.
“I know nothing about them. Do they still have a grant?” asked Karen Egozi, chief executive of the Doral-based Epilepsy Foundation.
Enroll America, a nonprofit working to expand healthcare coverage, opened its Florida headquarters in Miami in July and has since hosted more than 400 events throughout Miami-Dade and partnered with dozens of like-minded groups — but not NHCOA.
“We reached out to every navigator and ... organization that we learned about, and worked with every one that wanted to work with us,” said Nick Duran, Enroll’s state director. He added that the first joint event with NHCOA has been scheduled for Saturday.
Another Hispanic outreach group working in Miami-Dade, the Hispanic Access Foundation, said it also has partnered with churches and groups like Enroll America.
Have foundation workers ever encountered NHCOA navigators while in South Florida?
“Never,” said the group’s organizer, Luz Marina Terreros.
And the group is not among four others announced as part of a bilingual education and enrollment drive that targeted Hispanics in Homestead on Saturday, an event that included representation from the National Council of La Raza and the Coalition of Florida Farmworker Organizations.
Hispanics as a group have large numbers of uninsured and a high rate of eligibility for government-assisted coverage. According to a February report issued by the U.S. Department of Health and Human Services, more than 8 million uninsured Hispanics nationwide qualify for Medicaid or financial aid to buy a health plan.
In Florida, about 3.4 million Hispanics qualify for some form of government help getting coverage, according to the report, and almost 1 million Hispanics are uninsured.
In the Miami-Hialeah region — an area highlighted in the report — about 394,000 residents are eligible uninsured Hispanics, accounting for about 37 percent of the statewide total.
With the highest uninsured rate of any ethnic or racial group, Hispanics were expected to be major beneficiaries of the health law.
In recent weeks, the administration has made a strong pitch to reach Hispanics, with the president appearing on Spanish-language TV networks to assure viewers that signing up for healthcare will not lead to the deportation of relatives who are in the country illegally.
Only U.S. citizens and legal residents can benefit from the health law, and Hernandez-Lane said NHCOA navigators are not reaching out to Miami-Dade Hispanics who do not qualify.
She said the group had previously partnered with Abriendo Puertas — Opening Doors, in English — to promote civic engagement and empowerment of Hispanics. Public tax filings show that Abriendo Puertas received $95,000 in grants from NHCOA from 2010 to 2012 for Medicare anti-fraud programs.
“We didn’t just arrive there for the navigators program,” Hernandez-Lane said by telephone. “We have been there.”
Though others working to sign up consumers for coverage have not encountered NHCOA navigators at health fairs, enrollment drives or visits to Miami by Obama administration officials promoting the health law, Hernandez-Lane said the group has counselors on the ground.
“Sometimes we can be invisible to the community,” she said, “but we are visible to the people who need us the most.”
Hernandez-Lane said her group has provided a navigator for a National Institutes of Health study of Hispanics, with a Miami field office led by the University of Miami.
A UM spokeswoman said the National Hispanic Council provides one navigator one day a week to help study participants who are uninsured.
The council also has a local office. On a recent weekday morning, six NHCOA navigators dressed in dark blue polo shirts identifying them as “Navegadores” prepared to open their doors at the office in Little Havana, in a small building behind the headquarters for Abriendo Puertas on Southwest First Street. A sign for Abriendo Puertas hangs over the door.
Four people signed in during the first half-hour, meeting with NHCOA navigators who worked on laptop computers and counseled the consumers in Spanish about their insurance options and eligibility for financial aid.
Alice Gonzalez, navigator program coordinator, said the group had been in the Little Havana office since Oct. 1. NHCOA had no state-licensed navigators at the time. She said workers set up the office and educated consumers while awaiting approval.
Hernandez-Lane said NHCOA is now running full steam in Miami-Dade, making pitches to consumers on Spanish-language radio and participating at community events such as the Calle Ocho street festival last weekend.
“We have had more people calling and making appointments and getting ready to enroll,” Hernandez-Lane said.
The federal government tracks navigators’ progress through weekly phone calls and quarterly financial reports. But the Centers for Medicare and Medicaid Services, the federal agency that administers the navigators program, has refused to disclose enrollment and outreach reports for any of the grantees working in South Florida.
Hernandez-Lane said her group has helped 350 people select plans. She said she did not know how many were referred to Medicaid or how many selected a health plan.
CMS would not verify the numbers provided by any of the navigators, but the Epilepsy Foundation said it helped 498 consumers enroll for coverage in Miami-Dade, including 383 who selected a health plan and 115 who were referred to Medicaid.
And at Jackson Health System, where the Public Health Trust received a $238,000 navigator grant in late October — two months after NHCOA and the Epilepsy Foundation — navigators reported enrolling a total of 366 consumers, some in a subsidized health plan, others in Medicaid, from Dec. 1 to March 1.
And then there are the looser, more general “outreach” numbers cited by navigators. NHCOA says it reached lots of people in person — a total of 4,520. Epilepsy Foundation reports its navigators reached 3,129, and Jackson says they reached 1,280.
But Hernandez-Lane’s numbers mean NHCOA’s 18 navigators would have had to counsel 53 people a day, at a minimum of 45 minutes each, every day, including weekends, from Dec. 12, when its counselors were first licensed in Florida, to March 7, when Hernandez-Lane reported the numbers.
If NHCOA navigators were working at such a furious pace, then their efforts were not visible to other groups also working in South Florida.
“National who?” asked Jason Conner, who manages a team of 10 full-time enrollment counselors at Miami’s Borinquen Medical Centers, a network of federally qualified health clinics that help enroll consumers separately from navigators.
“When it comes to what they do,” said Paul Velez, chief executive of Borinquen, “they’re not a name in healthcare. There’s not even an affiliate here.”
Hernandez-Lane said NHCOA is working to change that perception in South Florida. The group registered as a nonprofit corporation with the state in November, because, she said, “We want to eventually be able to set the roots and get into these communities that need our presence.”